Management of advanced epithelial ovarian cancer in the older patient: an age stratified cohort study of a gynaecological cancer centre in Southern England

This was an age-stratified, retrospective, cohort study of patients between the ages of 65–69, 70–75 and ≥76 years diagnosed with high grade serous ovarian cancer of FIGO (2014) Stage 3a or higher between 01 January 2017 and April 2020. The study aimed to examine and compare patient characteristics, treatments and outcomes, including survival, of elderly patients within a single cancer centre in the south of England. Data collection began in January 2021 and concluded in March 2022. Ninety patients were eligible for the study. A correlation was observed between increasing age and worsening performance status (p = 0.044). Other variables assessed included age at diagnosis and time between decision to treatment, however, there was no evidence of correlations. The majority of patients studied received neoadjuvant chemotherapy followed by cytoreductive surgery as their primary treatment modality, however, 53%of our eldest cohort underwent treatment types that did not involve surgery. Of those who did undergo surgery, there was no observed correlation between age and the rates of complete cyto-reductive surgery, intra-operative complications, admission to High Dependency Unit, or length of hospital stay. Median length of stay across all age groups was 5 days. Patients ≥76 years were more likely to receive single-agent carboplatin (p = 0.009) than dual-agent chemotherapy. There was no increase in chemo-toxicity events with increasing age. While primary cytoreductive surgery is favoured by many gynaecological oncology teams, neoadjuvant chemotherapy still offers a viable treatment alternative for elderly and frail patients with advanced stage ovarian cancer by minimising operative times, reducing admissions to high dependency units and shortening lengths of hospital stay. Geriatric assessments, in combination with performance status, may aid treatment decisions made by the multi-disciplinary team.